What you can expect in 2014 from the Affordable Care Act (ACA)

If you are uninsured, purchase individual coverage or believe your employer provided coverage is inadequate or unaffordable, you will be able to shop for coverage directly in the federal Health Insurance Marketplace — a new competitive marketplace where individuals and small businesses can shop for and compare affordable and qualified health benefit plans. The Health Insurance Marketplace will offer you a choice of health plans that meet certain benefits and cost standards. Open enrollment for 2014 is October 1, 2013 – March 31, 2014.

For coverage to begin on January 1, 2014, you must enroll by December 23, 2013. For more information, visit: www.healthcare.gov.

Likely Medicaid Expansion
Pending federal approval of Michigan’s plans, residents who earn less than 133 percent of the federal poverty level will be eligible to enroll in Medicaid in the spring of 2014. Income may be the only determining factor for eligibility. (The federal poverty level is adjusted annually. In 2013, 133% of the poverty level for Michigan residents was about $14,856 for an individual or $30,657 for a family of four.) For more information call 855-789-5610.

Financial Help to Purchase Health Care Coverage
In 2014, federal tax credits to assist with the cost of health coverage in the Health Insurance Marketplace may be available for those with income between 100 percent and 400 percent of the federal poverty level who are not eligible for other affordable coverage. (The federal poverty level is adjusted annually. In 2013, 400 percent of the poverty level for Michigan residents was about $45,960 for an individual or $94,200 for a family of four.) To apply for the tax credit, visit the Health Insurance Marketplace: www.healthcare.gov.

Health Coverage Requirement
In 2014 and beyond, the “individual mandate” provision of the Patient Protection and Affordable Care Act (ACA) requires that people obtain health insurance or pay a federal tax penalty. If you currently have coverage from Medicare, Medicaid or an employer, you are considered covered and will not pay a tax penalty.

Those who do not have or do not obtain coverage will pay a tax penalty. The amount of the penalty for an individual is phasing in as follows:

No Denial for People with an Illness or Chronic Condition
Beginning in 2014, no insurance company can turn you down, charge you more or impose a waiting period for coverage because you have a pre-existing medical condition.

WHAT IS ALREADY IN EFFECT:

While many provisions of the Affordable Care Act (ACA) do not take effect until 2014, the following is a list of changes that applied to most health coverage starting on or after September 23, 2010.

No-Cost Preventive Care
New health plans must eliminate any cost-sharing for certain preventive services. Health carriers cannot charge a deductible, copay, or coinsurance for preventive care measures such as flu shots and other immunizations, mammograms and other cancer screenings, diabetes screenings and more.

Ban on Health Policy Rescissions
Health carriers are prohibited from rescinding or retroactively canceling your health coverage unless you committed fraud or made an intentional misrepresentation of an important fact on your application.

No Lifetime Limits on Your Health Care Costs
For new plans, health carriers will be prohibited from setting lifetime limits on significant benefits, such as hospitalization and emergency services. The ACA also restricts and phases out the annual dollar limits a health plan can place on most of your benefits – and eliminates these limits entirely in 2014.

Extended Coverage for Young Adults
Most health carriers and employers providing dependent coverage to children are required to make coverage available to adult children up to age 26. This applies to adult children who do not have access to coverage from their own job and regardless of whether or not they are students, financially dependent on their parents, live with their parents or are married.

No Denial for Children with an Illness or Chronic Condition
Health carriers are prohibited from denying coverage for children under the age of 19 because of a medical condition.

Medicare Prescription Drug Discounts
Seniors who are in the Medicare prescription drug coverage gap known as the “donut hole” will receive discounts on covered prescription drugs.

Help for Small Business
Some small businesses may qualify for a small business tax credit to help offset the costs of providing health insurance for employees. To be eligible for the credit in 2014, the small business would have to purchase coverage in the SHOP Marketplace. Small businesses may wish to contact an agent or carrier to assist with purchasing coverage from the SHOP Marketplace as use of the website is delayed for a year. For more information, visit www.healthcare.gov/small-businesses.